Resumen

GRIGNOLA, Juan C. et al. Tratamiento específico de la hipertensión arterial pulmonar: Experiencia de la policlínica de hipertensión pulmonar del Hospital Maciel, período 2009-2011. Rev.Urug.Cardiol. [online]. 2012, vol.27, n.2, pp.132-142. ISSN 1688-0420.

Summary  Introduction: pulmonary hypertension (PH) is a hemodynamic condition defined as an increase in mean pulmonary arterial pressure (mPAP) ³ 25 mmHg at rest as assessed by right heart catheterization (RHC). We report the experience in the PH diagnosis, follow-up and treatment (groups 1 and 4 of DanaPoint) of the PH clinic of the Hospital Maciel. Methods: we analyzed a cohort of 15 patients (2009-2011). We estimated the functional class (FC), the six-minute walk distance (6MWD), the tricuspid annulus plane systolic excursion (TAPSE) and the peak systolic velocity (Sm). The hemodynamic severity was estimated by RHC. Acute vasoreactivity (AVT) positive response was defined as a decrease in mPAP ³ 10 mmHg, reaching an absolute mPAP £ 40 mmHg with an unchanged or increased cardiac index (CI). Data were expressed as mean ± SD. Student t test and Kruskal-Wallis test were used to compare the specific treatment effects and for multiple comparisons, respectively, with a p<0,05. Results: mean patient aged 43 ± 12 years, 12 (80%) women. 10 (67%) of group 1 y 5 (33%) of group 4. 20% p were in FC CF I-II and 80% in FC III-IV. The mean follow-up was 19 ± 11 months. Basal TAPSE and Sm were 17 ± 7 mm and 11 ± 2 cm/s, respectively. mPAP was 54 ± 15 mmHg, right atrial pressure 11 ± 6 mmHg, CI 2,1 ± 0,7 l/min/m², pulmonary vascular resistance 1.087 ± 625 dinas.s.cm^-5, pulmonary capacitance 1,3 ± 0,6 ml/mmHg. One patient presented a positive AVT. Patients were treated with sildenafil (100%), bosentan (50%) and iloprost (43%), and 71% received a combination therapy. We did not report hepatotoxicity by bosentan during the follow-up period. One patient refused to receive specific therapy and died. The remaining 14 patients improved their FC (3,0 ± 0,8 versus 2,1 ± 0,8, p<0,05), and trended towards an improved of 6MWD (381 ± 117 versus 424 ± 107m, p=0,1), with no change of RV function at rest. 6MWD correlated with FC, while the worse FC, the higher hemodynamic severity (non-significant tendency). Conclusions: PH affects young patients, being detected in late stages of the illness with severe hemodynamic impairment, requiring sequential combination therapy. 6MWD correlated with FC. We recommend the development of early detection programs (associated conditions) and the access of parenteral prostacyclins.

Palabras clave : HYPERTENSION PULMONARY; ILOPROST; SILDENAFIL; BOSENTAN.

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